Tratamiento de las infecciones hospitalarias por staphylococcus aureus meticilino resistente / Treatment of hospital-acquired methicillin-resistant staphylococcus aureus infections / Tratamento de infecções por Staphylococcus aureus resistentes à meticilina, adquiridas em hospitais

Introducción: la infección por Staphylococcus aureus meticilino resistente, una de las principales bacterias causantes de infecciones hospitalarias, se ha convertido en una preocupación mundial dada la alta tasa de morbilidad y mortalidad que produce. La resistencia bacteriana es un factor que agrava la problemática de infecciones hospitalarias y se asocia fundamentalmente al uso inadecuado de antibióticos. El uso prudente de los mismos ayuda a controlar la resistencia bacteriana, sin embargo, cada vez se detectan más cepas resistentes a diversos antibióticos. Se realiza una revisión de tratamientos antibióticos disponibles para las infecciones hospitalarias producidas por Staphylococcus aureus meticilino resistente en paciente adulto, con la finalidad de proporcionar una guía sobre los mismos, que permita un uso racional de los antibióticos disponibles evitando así que se continúe desarrollando el fenómeno de resistencia bacteriana. Metodología: se realizó un estudio observacional, descriptivo, de tipo revisión literaria, restringiéndose la búsqueda a guías de práctica clínica. Para conocer las guías existentes en Uruguay se consultó la Cátedra de Enfermedades Infecciosas de la Facultad de Medicina, Universidad de la República y en el Ministerio de Salud Pública. Se encontraron y analizaron guías de diferentes países. Existe acuerdo en los lineamientos generales del tratamiento farmacológico de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Resultados: en Uruguay no existen guías propias de tratamiento de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Se utiliza como referencia la guía publicada por la Infectious Diseases Society of America. Discusión: algunos de los antibióticos recomendados en las guías analizadas no se encuentran disponibles en nuestro país, como es el caso de daptomicina, telavancina y cloxacilina. En particular, el no disponer de daptomicina podría llegar a dificultar el tratamiento de infecciones en las cuales la CIM de vancomicina sea mayor a 1.5 mg/L. Conclusiones: por lo tanto, se considera conveniente y necesario pautar el tratamiento de dichas infecciones, acorde a las posibilidades, a la epidemiología de nuestro país y a los patrones de resistencia a ésta bacteria, para unificar la práctica clínica y hacer un uso racional de los antibióticos de manera de evitar promover el fenómeno de resistencia microbiana.

Introduction: infection by methicillin-resistant Staphylococcus aureus, one of the main bacteria causing hospital infections, has become a worldwide concern due to the high morbidity and mortality rate it produces. Bacterial resistance is a factor that aggravates the problem of hospital infections and is mainly associated with the inappropriate use of antibiotics. The prudent use of antibiotics helps to control bacterial resistance; however, more and more strains resistant to different antibiotics are being detected. A review of available antibiotic treatments for hospital infections caused by methicillin-resistant Staphylococcus aureus in adult patients was carried out in order to provide a guide for a rational use of available antibiotics, thus avoiding further development of the phenomenon of bacterial resistance. Methodology: an observational, descriptive, literature review type study was carried out, restricting the search to clinical practice guidelines. In order to know the existing guidelines in Uruguay, the Department of Infectious Diseases of the School of Medicine, University of the Republic and the Ministry of Public Health were consulted. Guidelines from different countries were found and analyzed. There is agreement on the general guidelines for pharmacological treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. Results: in Uruguay there are no guidelines for the treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. The guidelines published by the Infectious Diseases Society of America are used as a reference. Discussion: some of the antibiotics recommended in the guidelines analyzed are not available in our country, as is the case of daptomycin, telavancin and cloxacillin. In particular, the unavailability of daptomycin could make the treatment of infections in which the MIC of vancomycin is higher than 1.5 mg/L more difficult. Conclusions: therefore, it is considered convenient and necessary to establish guidelines for the treatment of such infections, according to the possibilities, to the epidemiology of our country and to the resistance patterns to this bacterium, in order to unify clinical practice and make a rational use of antibiotics so as to avoid promoting the phenomenon of microbial resistance.

Introdução: a infecção por Staphylococcus aureus resistente à meticilina, uma das principais bactérias causadoras de infecções hospitalares, tornou-se uma preocupação mundial devido à alta taxa de morbidade e mortalidade que ela causa. A resistência bacteriana é um fator que agrava o problema das infecções adquiridas nos hospitais e está principalmente associada ao uso inadequado de antibióticos. O uso prudente de antibióticos ajuda a controlar a resistência bacteriana, entretanto, cada vez mais estirpes resistentes a vários antibióticos estão sendo detectadas. É realizada uma revisão dos tratamentos antibióticos disponíveis para infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina em pacientes adultos, com o objetivo de fornecer um guia para o uso racional dos antibióticos disponíveis, evitando assim o desenvolvimento posterior do fenômeno de resistência bacteriana. Metodologia: foi realizado um estudo observacional, descritivo, do tipo revisão de literatura, restringindo a busca às diretrizes da prática clínica. O Departamento de Doenças Infecciosas da Faculdade de Medicina da Universidade da República e o Ministério da Saúde Pública foram consultados para as diretrizes existentes no Uruguai. Foram encontradas e analisadas diretrizes de diferentes países. Há acordo sobre as diretrizes gerais para o tratamento farmacológico de infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina. Resultados: no Uruguai não há diretrizes para o tratamento de infecções por Staphylococcus aureus resistentes à meticilina adquiridas em hospitais. As diretrizes publicadas pela Sociedade de Doenças Infecciosas da América são usadas como referência. Discussão: alguns dos antibióticos recomendados nas diretrizes analisadas não estão disponíveis na Espanha, tais como daptomicina, telavancina e cloxacilina. Em particular, a indisponibilidade da daptomicina poderia dificultar o tratamento de infecções nas quais a MIC da vancomicina é maior que 1,5 mg/L. Conclusões: portanto, considera-se conveniente e necessário estabelecer diretrizes de tratamento para estas infecções, de acordo com as possibilidades, a epidemiologia de nosso país e os padrões de resistência a esta bactéria, a fim de unificar a prática clínica e fazer uso racional dos antibióticos, a fim de evitar a promoção do fenômeno da resistência microbiana.

Occurrence of blaKPC gene in clinical isolates of Pseudomonas aeruginosa from Brazil

Pseudomonas aeruginosa is one of the main microorganisms causing healthcarerelated infections. The rise of carbapenem-resistant P. aeruginosa (CRPA) strains has become a serious public health problem. Dissemination of the enzyme Klebsiella pneumoniae carbapenemase (KPC) encoded by the blaKPC gene cause the inactivation of ß-lactam antibiotics being one of the mechanisms involved in this resistance. Given the above, the objective of this review was to evaluate the occurrence of the blaKPC gene in clinical isolates of P. aeruginosa in Brazil. For this, the online databases used were: Lilacs, SciELO and PubMed. The search for articles included articles published from 2012 to 2020, using the following keywords: blaKPC (KPC), Pseudomonas aeruginosa, and Brazil (in Portuguese and English). Initially, 30 publications eligible for inclusion in this review were identified. After the first analysis, two articles were excluded due to duplication. Subsequently, titles and abstracts were evaluated, 15 articles were excluded because they did not fit the theme, and 13 articles that met the inclusion criteria were read in full. In these studies, the presence of the blaKPC gene was investigated in 566 clinical isolates of P. aeruginosa in Brazil, with 86 (15.2%) positive samples found. Pernambuco was the state with the highest number of articles and positive samples, respectively, 38.5% (5/13), and 65.1% (56/86). This study reinforces the need to investigate the occurrence of this gene in all regions of the country in CRPA, aiming to understand how its dissemination occurs and to promote prevention and therapeutic strategies.

Infección urinaria nosocomial y microorganismos implicados / Nosocomial urinary infection and implicated microorganisms

Introducción: Las infecciones urinarias nosocomiales constituyen una complicación frecuente e importante problema de salud debido complicaciones y recidivas frecuentes. Se pretende identificar los microorganismos implicados en las infecciones urinarias nosocomiales, su relación con el uso de sonda y estancia hospitalaria. Materiales y métodos: Estudio descriptivo­retrospectivo. Se revisaron bases de vigilancia epidemiológica restringiendo a infección de vías urinarias de origen hospitalario; se describieron las características generales y se exploraron diferencias entre los tiempos de estancia por microorganismo por Kluskal Wallis para un nivel de significancia del 95%. Resultados: Se encontraron 167 de infección de vías urinarias de origen hospitalario, la mediana de edad fue de 75 años; la mayoría de género femenino (58%), 34,1% asociadas al uso de sonda; 10% fallecieron en la hospitalización, la mayoría provenían de la unidad de cuidados intensivos adultos. El microorganismo más frecuentemente aislado fue Escherichia coli (46,1%); los pacientes aportaron una mediana de estancia de 20 días. Se encontraron diferencias significativas en los tiempos de estancia por microorganismo aislado en infección urinaria asociada a sonda, el microorganismo relacionado con los mayores tiempos de estancia fue Proteus mirabillis; el resto de diferencias no fueron significativas. Conclusiones: El microorganismo más frecuentemente aislado fue Escherichia coli, el Proteus mirabillis se encontró fue el más relacionado con uso sonda y tiempo de estancia, se requieren estudios adicionales para determinar asociaciones entre la estancia hospitalaria y fenotipos de resistencia, los protocolos de tratamiento empírico disponibles a la fecha, concuerdan los microorganismos aislados.

Introduction: The nosocomial urinary tract infections are a common complication and a major health problem due to complications and frequent recurrences. It aims to identify microorganisms involved in nosocomial urinary infections, their relationship with the use of probe and hospital stay. Materials & methods: A descriptive retrospective study. Surveillance bases restricting urinary tract infections hospital origins were reviewed; general characteristics were described and differences between the lengths of time of stay were screened by microorganism Kluskal Wallis for a significance level of 95%. Results: 167 urinary tract infections were found of hospital origin, the median age was found to be of 75; most females (58%), 34.1% associated with the use of probe; 10% died in the hospital, most came from the adult intensive care unit. The most frequently isolated microorganism was Escherichia coli (46.1%); patients contributed a median stay of 20 days. Significant differences in length of stay by microorganism isolated in catheter-associated urinary tract infection was found, the microorganism related to the greatest length of stay was Proteus mirabilis; the remaining differences were not significant. Conclusions: The most frequently isolated microorganism was Escherichia coli, Proteus mirabilis was found to be related to probe the use and length of stay, additional studies are required to determine associations between hospital stay and resistance phenotypes empirical treatment protocols available to the date, consistent microorganisms isolated.

Cumplimiento del Protocolo de Lavado de Manos por profesionales de enfermería en un servicio de salud de la ciudad de Encarnación, marzo-julio del 2019 / Compliance with the handwashing protocol by nursing professionals in a health service of the city of Encarnacion, March-July 2019

El cumplimiento del protocolo de lavado de manos evita las infecciones nosocomiales, mientras que el incumplimiento ocasiona consecuencias como el aumento de la morbimortalidad, la estancia hospitalaria, así como gastos adicionales al sistema sanitario y al usuario. Esto se puede prevenir con el lavado de manos que surgió como teoría desde la antigüedad. El trabajo de investigación fue de tipo observacional descriptivo con enfoque cuantitativo y fue realizado en 24 enfermeros de un servicio de salud de la ciudad de Encarnación con el objetivo de evaluar el cumplimiento del protocolo del lavado de manos establecido en el Manual de Prevención y Control de Infecciones asociado a la Atención de la Salud del año 2017 del Ministerio de Salud Pública y Bienestar Social. Los resultados evidenciaron un 54% de incumplimiento en la técnica de lavado de manos, un 44% de incumplimiento parcial y solamente un 2% de cumplimiento. En cuanto a los cinco momentos del lavado de manos, el 85% no cumplió con todos los momentos y un 70% no ha recibido capacitación referente al lavado de manos en los últimos 2 años. Se evidenció un alto porcentaje de incumplimiento del protocolo de lavado de manos, lo que representa un riesgo para la salud que podría subsanarse con la realización de cursos de capacitaciones o retroalimentación a los profesionales de enfermería

Compliance of handwashing protocol avoid nosocomial infections, while non-compliance causes consequences such as increased morbidity and mortality, hospital stay, additional cost to the health system and the patient. This can be prevented with handwashing which emerged as a theory in ancient times. This study was descriptive observational with quantitative approach and was carried out in 24 nurses at a health service in the city of Encarnacion in order to evaluate the compliance of handwashing protocol, established in the Infection Prevention and Control Manual associated to Health Care of 2017 of the Ministry of Health Care and Social Welfare. The results showed 54% of non-compliance in the handwashing technique, 44% of partial non-compliance and just 2% of compliance. In relation to the five moments of handwashing technique, 85% did not follow all the steps and 70% did not receive training regarding to the hand washing technique in the last 2 years. A high percentage of non-compliance with the hand washing technique protocol was evidenced, which represents a health risk, which can be corrected with training or feedback workshops for nursing professionals

Ozono como método de desinfección del ambiente hospitalario / Ozone a method of disinfection of the environment of hospitals

Resumen Justificación y objetivo: Las infecciones asociadas a la asistencia sanitaria elevan los costos, prolongan la estadía hospitalaria e incrementan la mortalidad, por lo que se hace necesaria la desinfección ambiental como método de disminuir este problema. El objetivo del estudio fue evaluar el impacto del uso del ozono para la desinfección ambiental, en áreas de alto riesgo hospitalario. Métodos: Se realizó una intervención para la desinfección de ambiente con el empleo de equipos de ozono en áreas de alto riesgo del Instituto de Neurología y Neurocirugía de Cuba, y se evaluó el resultado mediante las siguientes variables: estado microbiológico ambiental, número de fallecidos en general, por sepsis, y consumo de antibióticos durante enero - junio de 2019. Resultados: De las 12 áreas evaluadas, previo a la aplicación de ozono ambiente, teniendo en cuenta la cantidad de unidades formadoras de colonias por m3, 2 se clasificaron como ambiente no aceptable, 3 como ambiente aceptable, 7 como ambiente limpio. Posterior a la aplicación de ozono, se obtuvo en las 12, resultados correspondientes a ambiente muy limpio. El consumo de antibióticos disminuyó a un tercio en las áreas expuestas evaluadas y se elevó en las no expuestas. Hubo menor número de fallecidos que en similar periodo del año anterior a la intervención. Conclusiones: La desinfección ambiental con ozono en áreas hospitalarias de alto riesgo fue útil para generar ambientes limpios, y favorecer la disminución del consumo de antibióticos, la estadía hospitalaria y la mortalidad por infecciones asociadas a la asistencia sanitaria.

Summary Background and aim: Health care-associated infections raise costs, prolong hospital stays and increase mortality, making environmental disinfection necessary as a method of reducing this problem. The aim of this study was to evaluate the impact of the use of ozone for environmental disinfection in areas of high hospital risk. Methods: An intervention was carried out to disinfect the environment with the use of ozone equipment in high-risk areas of the Cuban Institute of Neurology an Neurosurgery and the result was evaluated using the following variables: environmental microbiological status, number of deaths in general and for sepsis, and consumption of antibiotics from January to June 2019. Results: Of the 12 areas evaluated, prior to the application of ozone, taking into account the number of colony forming units per m3, 2 were classified as unacceptable, 3 as an acceptable environment and 7 as a clean environment . After the ozone application, the results of the 12 areas showed a very clean environment. Antibiotic use decreased to a third in the exposed areas evaluated and rose in the unexposed areas. There were fewer deaths than in a similar period of the year prior to the intervention. Conclusions: Environmental disinfection with ozone in high-risk hospital areas is useful to generate clean environments, and favor the decrease in antibiotic consumption and mortality due to infections associated with healthcare.

Knowledge and attitude study among the nursing staff working in a tertiary care hospital in Southern India

Background: Hand hygiene is recognised as one of the leading measure to prevent cross transmission of micro-organisms. Inadequate hand hygiene practices are common cause of nosocomial infections. Nurses are considered as the “nucleus of health care system” Because of the time they spend with patients than any other health care workers. Hence their compliance with hand washing guidelines seems to be more vital in preventing the disease transmission among patients.Methods: Despite the simplicity of the procedure, compliance with hand hygiene among health care providers in particular nurses is as low as 40%. This study aims at assessing knowledge, attitude and practice of hand hygiene of the nursing staff working in a tertiary care hospital.Results: Among the 140 study participants 74% were female nurses. Majority of the study participants (78%) had average knowledge of hand hygiene in the pre-test session The health education and training session on correct hand hygiene methods significantly(p<0.001) improved the knowledge and attitude of the nursing staff, during the post-test session 87% of the nurses had good knowledge and 100% had positive attitude.Conclusions: Our study shows the importance of improving the current training programmes targeting the hand hygiene practices among nursing staff. Hand hygiene training sessions need to be conducted more frequently with continuous monitoring and performance feedback to encourage them and their fellow nurses to follow correct hand hygiene practices.

Prevalência e perfil de suscetibilidade a antimicrobianos de microrganismos isolados em culturas de cateter / Prevalence and antimicrobial susceptibility profile of isolated microorganisms in catheter cultures

Introdução: os cateteres intravenosos são de uso amplamente difundido em hospitais e por estarem em contato direto com a circulação sanguínea, tornam­se um potencial risco para a ocorrência de contaminação e infecção local e sistêmica, aumentando a mortalidade, o tempo de internação e consequentemente custos hospitalares. Objetivo: o presente estudo teve como objetivo realizar levantamento epidemiológico da prevalência de bactérias e fungos em pontas de cateteres provenientes de sete hospitais do município de Cascavel ­ Paraná. Metodologia: foi realizado um estudo transversal por meio da coleta de dados em laudos emitidos por um laboratório clínico privado do mesmo município, entre os anos de 2011 a 2014. Resultados: verificou­se positividade em 21,7% dos laudos analisados (248). O grupo dos bacilos Gram negativos fermentadores (BGN) foi o mais prevalente, sendo as principais bactérias encontradas Escherichia coli e Klebsiella pneumoniae (84 laudos), seguidos de BGN não­fermentadores (79 laudos) e cocos Gram positivos (67 laudos). Leveduras foram encontradas em 18 laudos. Staphylococcus aureus apresentaram uma resistência de 31,8% para oxacilina, sendo para Staphylococcus coagulase­negativa resistência de 86,9%. Klebsiella pnemoniae apresentou discreta resistência para ertapenem (9,5%), imipenem (7,1%) e meropenem (7,1%), sugerindo presença de carbapenemase. Espécies de Enterobacter foram resistentes a diversos antimicrobianos, não constatado resistência aos carbapenêmicos ertapenem, imipenem e meropenem. Acinetobacter baumanii e Pseudomonas aeruginosa apresentaram elevada resistência para imipenem e meropenem (77,1% e 45,2%; 80% e 51,6%, respectivamente). Candida albicans apresentou 100% de suscetibilidade aos antifúngicos utilizados. Conclusão: esses resultados demonstram a grande importância no manejo eficiente do controle de infecção hospitalar e uso responsável de antimicrobianos por hospitais.

Introduction: intravenous catheters are widely used in hospitals, and they become a potential risk for local and systemic contamination due to direct contact with blood circulation, increasing mortality, length of hospital stay and consequently hospital costs. Objectives: the present study aimed to conduct an epidemiological survey of bacteria and fungi prevalence in catheter tips from seven hospitals in Cascavel county ­ Paraná. Methodology: a cross­sectional study was performed by data collection in reports issued by a private clinical laboratory in the same municipality from 2011 to 2014. Results: positive results were found in 21.7% of analyzed reports (248). The Gram negative bacilli fermenting (BGN) group was the most prevalent, being main bacterias Escherichia coli and Klebsiella pneumoniae (84 reports), followed by non­fermenting BGN (79 reports) and Gram positive cocci (67 reports). Yeasts were found in 18 reports. Staphylococcus aureus showed a resistance of 31.8% for oxacillin, and resistance for Staphylococcus coagulase­negative of 86.9%. Klebsiella penmoniae presented a mild resistance to ertapenem (9.5%), imipenem (7.1%) and meropenem (7.1%), suggesting presence of carbapenemase. Enterobacter species were resistant to several antimicrobials, no resistance to carbapenems ertapenem, imipenem and meropenem. Acinetobacter baumanii and Pseudomonas aeruginosa presented high resistance to imipenem and meropenem (77.1% and 45.2%, 80% and 51.6%, respectively). Candida albicans showed 100% susceptibility to antifungals used. Conclusion: these results demonstrate great importance in the efficient management of hospital infection control and responsible use of antimicrobials by hospitals

Analysis of pathogen spectrum and antimicrobial resistance of clinical common organisms from twelve teaching hospitals in 2016 / 中华检验医学杂志

Objective To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China, 2016. Methods Non-duplicated nosocomial cases as well as pathogens causing bloodstream infections ( BSI) , hospital-acquired pneumonia ( HAP) and intra-abdominal infections ( IAI ) from 12 teaching hospitals across China were collected. The minimum inhibitory concentrations (MICs) of important clinical common strains were determined by agar dilution method or broth microdilution method. The CLSI M100-S27 criteria was used for interpretation. Data were analyzed by using WHONET-5. 6 software. Results A total of 2060 cases were collected, including 894 cases from BSI, 630 cases from HAP and 536 cases from IAI. The MICs of 1896 important clinical common strains were determined. Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI, while Acinetobacter baumanii and Pseudomonas aeruginosa were dominated in HAP. All Staphylococcus aureus were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. Methicillin-resistant S. aureus accounted for 44. 4％ ( 75/169 ) of all the S. aureus. The rate of methicillin-resistant coagulase-negative staphylococci was 80. 9％ ( 72/89 ) . No Enterococcus strains were found resistant to tigecycline, linezolid or daptomycin. Vacomycin resistant enterococcus was found in Enterococcus faecium, accounting for 1. 8％ ( 2/111 ) of all E. faecium strains. Tigecycline, meropenem, amikacin, imipenem, and polymyxin B exhibited high potency against Enterobacteriaceae and the susceptibility rates were 96. 6％(865/895), 94. 3％ (859/911), 94. 2％ (858/911), 94. 1％ (857/911), and 91. 6％ (820/895), respectively. The prevalence of extended-spectrum β-lactamase was 58. 4％ ( 263/450 ) in E. coli and 28. 6％ ( 84/294 ) in K. pneumonia. The rate of carbapenem resistant K. pneumonia and E. coli was 15. 3％ ( 45/294 ) and 1. 8％ ( 8/450 ) , respectively. The percentage of polymyxin B resistant K. pneumonia and E. coli was 4. 1％ ( 12/294 ) and 4. 4％ ( 20/450 ) , respectively. The rate of tigecycline resistant K. pneumonia and E. coli was 2. 4％ ( 7/294 ) and 0. 2％ ( 1/450 ) , respectively. A. baumanii showed low susceptibility to the antimicrobial agents except tigecycline ( 91. 4％, 235/257 ) and polymyxin B (100％, 257/257). The rate of carbapenem resistant A. baumanii was 80. 5％ (207/257). The rate of carbapenem resistant P. aeruginosa was 31. 7％ ( 59/186 ) . Polymyxin B and amikacin demonstrated high antibacterial activity against P. aeruginosa with susceptility rate of 100％ ( 186/186 ) and 90. 9％ ( 169/186), respectively. Conclusions Nosocomial pathogens showed high susceptibilities against tigecycline and polymyxin B. Antimicrobial resistance in A. baumannii is a serious problem. The prevalence of carbapenem-resistant Enterobacteriaceae and polymyxin B resistant Enterobacteriaceae has increased, which should be monitored continuously in China.

Probióticos en diarrea aguda, asociada a antibióticos y nosocomial: evidencia en pediatría / Probiotics in Acute, Antibiotic-associated and Nosocomial Diarrhea: Evidence in Pediatrics

Resumen Introducción: los probióticos son microorganismos vivos que, administrados en cantidades adecuadas, proveen una acción benéfica en el ser humano. Existen numerosos estudios acerca de su uso en enfermedad diarreica en pediatría, por lo que se hace necesario evaluar la evidencia. Métodos: se realizó una revisión de la literatura incluyendo solo metaanálisis y revisiones sistemáticas en los últimos 10 años acerca del uso de probióticos en diarrea aguda, diarrea asociada a antibióticos y Clostridium difficile, y diarrea nosocomial. Resultados: en diarrea aguda, los metaanálisis muestran disminución de la duración en un día (intervalo de confianza [IC] 95%; 15,9 a 33,6 horas) y disminución del riesgo de prolongación en los siguientes 4 y 7 días, con recomendaciones fuertes y evidencia moderada para Lactobacillus rhamnosus GG y Saccharomyces boulardii. En diarrea asociada a antibióticos y a C. difficile, los metaanálisis mostraron reducción del riesgo entre el 50% y 60%, con recomendación fuerte para L. rhamnosus GG y S. boulardii con un número necesario a tratar (NNT) de 10 (IC 95%; 7-12). En diarrea nosocomial, se encontró evidencia moderada con el uso de L. rhamnosus GG, principalmente en reducción del riesgo de gastroenteritis sintomática por rotavirus. Sin evidencia suficiente para dar recomendación para las cepas Streptococcus thermophilus y Bifidobacterium bifidum. Conclusión: solo existe evidencia con los probióticos L. rhamnosus GG y S. boulardii en reducción de la duración y disminución del riesgo de prolongación de diarrea aguda, así como reducción del riesgo entre 50% y 60% de diarrea asociada a antibióticos. Existe evidencia moderada con L. rhamnosus GG, en la reducción de riesgo de diarrea nosocomial.

Abstract Introduction: Probiotics are live microorganisms which, when administered in adequate amounts, provide beneficial action in humans. There are numerous studies about their use to treat diarrhea in pediatrics, so it is necessary to evaluate the evidence. Methods: We reviewed metaanalyses and systematic reviews in the last ten years about the use of probiotics to treat acute diarrhea, diarrhea associated with antibiotics and Clostridium difficile and nosocomial diarrhea. Results: Metaanalyses show that treatment of acute diarrhea with probiotics decreases duration by one day (95% CI: 15.9 to 33.6 hours) and reduces a risk of prolongation in the following four to seven days. They provide strong recommendations with moderate evidence for Lactobacillus rhamnosus GG and Saccharomyces boulardii. For diarrhea associated with antibiotics and Clostridium difficile, meta-analyses show risk reduction of between 50% and 60%, with strong recommendations for Lactobacillus rhamnosus GG and Saccharomyces boulardii with an NNT of 10 (95% CI: 7 to 12). For nosocomial diarrhea, moderate evidence was found for the use of Lactobacillus rhamnosus GG, mainly in reducing the risk of symptomatic gastroenteritis due to rotavirus. Currently, sufficient evidence does not exist to give recommendation for strains S. thermophiles and B. bifidum. Conclusion: For reducing the duration and reducing the risk of prolongation of acute diarrhea, evidence exists only for Lactobacillus rhamnosus GG and Saccharomyces boulardii. In addition, they reduce the risk of diarrhea associated with antibiotics by 50% to 60%. There is moderate evidence that Lactobacillus rhamnosus GG reduces the risk of nosocomial diarrhea.

What are the risk factors and agents responsible for bacterial infections in ICUS? / Quais os fatores de risco e agentes responsáveis por infecções bacterianas em UTI?

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

This study aimed to analyze the main risk factors and prevalence of microorganisms from patients admitted in adult andneonatal ICUs. This was a retrospective study using data of microbial cultures and their respective patients admitted inadult and neonatal ICUs of a university hospital from the central region of Rio Grande do Sul, Brazil. In the adult ICU,58.8% of patients presented heart problems, and 60 positive cultures were found with the prevalence of coagulasenegative Staphylococcus (CNS) (30.0%) and Staphylococcus aureus (13.3%). In the neonatal ICU, patients predominantlypresented pulmonary diseases (52.6%), and 31 positive cultures were found with the prevalence of CNS (35.5%) andEnterococcus spp. (16.1%). Thus, we conclude that both units surveyed had patients with different risk factors but withinfections caused by Gram positive cocci, mainly CNS

Este estudo objetivou analisar os principais fatores de risco e a prevalência de microrganismos em infecções bacterianas de pacientes internados em UTIs Adulto e Neonatal. Estudo retrospectivo onde foram incluídos dados de culturas dos microrganismos e dos respectivos pacientes internados nas UTIs Adulto e Neonatal de um hospital escola do Vale do Rio Pardo, localizado na região central do RS. Na UTI Adulto 58,8% dos pacientes apresentaram problemas cardíacos,foram encontradas 60 culturas positivas com a prevalência de Staphylococcus coagulase negativa (SCN) (30%) eStaphylococcus aureus (13,3%). Na UTI Neonatal os pacientes apresentaram predomínio de doenças pulmonares(52,6%), foram 31 culturas positivas neste período com maior prevalência de SCN (35,5%) e Enterococcus spp. (16,1%).Desta forma, conclui-se que as duas unidades analisadas possuem pacientes diferentes com fatores de risco distintos,mas com o predomínio de infecções por cocos Gram positivos, principalmente SCN

Prescripción de antibioticoterapia por vía parenteral en un servicio de cirugía general de Santiago de Cuba / Parenteral antibiotic therapy prescription in a general surgery service of Santiago de Cuba

Se realizó un estudio analítico y transversal, del tipo indicación-prescripción de medicamentos, de 254 pacientes atendidos en el Servicio de Cirugía General del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres de Santiago de Cuba, de enero a mayo de 2016, con vistas a analizar la prescripción de antibióticos de administración parenteral por parte del personal médico de esta área. En la serie las infecciones resultaron más frecuentes en el sexo masculino (53,1 por ciento y en los grupos etarios de 45 a 64 años (42,1 por ciento). Asímismo, predominó el criterio de aplicar terapia antimicrobiana empírica (71,7 por ciento) y en general, las indicaciones correspondieron a la amikacina 144 (25,2 por ciento), 121 al metronidazol (21,2 por ciento) y 118 a la penicilina cristalina (20,7 por ciento); por otra parte, los gérmenes patógenos más aislados en el Servicio fueron la Escherichia coli, la Klebsiella, el enterobacter y el estafilococo coagulasa positivo.

An analytic and cross-sectional study, of the indication-prescription medications type, of 315 patients assisted in the General Surgery Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital was carried out in Santiago de Cuba, from January to May, 2016, aimed at analyzing the prescription of parenteral antibiotics on the part of the medical staff of this area. In the series the infections were most frequent in the male sex (53,1 percent) and in the 45 to 64 years group (42,1 percent). Also, the criterion of applying antimicrobians empirically prevailed (71,7 percent) and in general, indications corresponded to amikacin 144 (25,2 percent), 121 to metronidazole (21,2 percent), and 118 to crystalline penicillin (20,7 percent); on the other hand, the most isolated pathogens in the Service were Escherichia coli, Klebsiella, enterobacter and positive coagulase staphylococcus.

Carbapenem-resistant Acinetobacter baumannii contamination in an intensive care unit

Abstract INTRODUCTION: Acinetobacter baumannii is a major pathogen causing infections in intensive care units (ICUs). In this study, we aimed to evaluate the presence of A. baumannii in an ICU environment and gloves from ICU workers and to characterize the antimicrobial resistance of the isolates in comparison with those isolated from ICU patients at the same hospital. METHODS: ICU samples were collected from March to November 2010. Isolates biochemically characterized as Acinetobacter calcoaceticus-Acinetobacter baumannii complex were evaluated by PCR targeting the 16S rDNA and bla OXA-51 genes. Antimicrobial susceptibility was determined using the disk diffusion method, and carbapenem-resistant isolates were also evaluated for the minimum inhibitory concentration of imipenem using broth microdilution. The presence of the bla OXA-23 gene was evaluated in isolates with reduced susceptibility to carbapenems. RESULTS: A. baumannii was detected in 9.5% (84) of the 886 samples collected from the ICU environment, including from furniture, medical devices, and gloves, with bed rails being the most contaminated location (23.8%; 20/84). Multidrug-resistant (MDR) A. baumannii was found in 98.8% (83/84) of non-clinical and 97.8% (45/46) of clinical isolates. Reduced susceptibility to carbapenems was detected in 83.3% (70/84) of non-clinical and 80.4% (37/46) of clinical isolates. All isolates resistant to carbapenems harbored bla OXA-23. CONCLUSIONS: We found a strong similarity between the antimicrobial susceptibility profiles of non-clinical and clinical A. baumannii isolates. Such data highlight the ICU environment as a potential origin for the persistence of MDR A. baumannii, and hence the ICU may be a source of hospital-acquired infections caused by this microorganism.

Closed-loop of workflow-based hospital infection control network / 中华医院管理杂志

Routine supervision on hospital infection control was normally fed back on paper-based media,plagued by low efficiency and poor traceability.A feedback process developed with Workflow technology,can loop the entire process ranging from routine supervision to identifying loopholes,to hospital infection and joint development of correctional measures clinically,all the way to implementation of infection control practice and sustained improvement.The closed-loop PDCA cycle management features greater efficiency and traceability in hospital management of its infection control,and builds a quality improvement model featuring close communication between infection control department and clinical departments.

Vigilancia de infecciones asociadas al cuidado de la salud en áreas no críticas del Hospital Dr. Julio C. Perrando, Año 2016 / Surveillance of infections associated with health care in non-critical areas of the Hospital Dr. Julio C. Perrando, Year 2016

Las infecciones asociadas a la atención de la salud son un problema de salud pública importante, debido a la frecuencia con que se producen, la morbilidad y mortalidad que provocan y la carga que imponen a los pacientes, al personal sanitario y a los sistemas de salud. El objetivo fue determinar la frecuencia y la tendencia de las infecciones asociadas al cuidado de la salud en áreas no críticas, durante el año 2016 en el Hospital Julio CPerrando. Se consideró infecciones asociadas al cuidado de la salud (IACS) a: "Toda infección que se inicia transcurridas las 48 hs de la admisión al hospital o dentro de los 30 días posteriores al alta"; y como infección del sitio quirúrgico a: "toda infección localizada en el sitio incisional que ocurre dentro de los 30 días posteriores a un procedimiento quirúrgico o hasta un año si hubiera implante de prótesis". Se realizó un estudio descriptivo, transversal, prospectivo. Se incluyó a todos los pacientes mayores de 14 años internados en este nosocomio que cumplan con la definición de caso. La recolección de datos se realizó diariamente y la información obtenida se registró en un formulario de confección propia. Se registraron un total de 429 infecciones, con una tasa de incidencia de 8,14 por 1000 pacientes internados por día en el año, con tendencia al descenso, siendo los servicios con mayor tasa los de Cirugía y Clínica

Summary: The infections asocciated with health care (HAI) are a major public health problem, due to the frecuency of they ocurrence, the morbidity and morbility they cause, and the burden they impose on patients, health personnel, and health systems. The aim was to determine the frecuency and trend of de infections asocciated with health care in non-critical areas of the Hospital Julio C Perrando during the year 2016. As infections associated with health care (HAI) were considered any infections that begin 48 hours from admission to the hospital or within 30 days afer discharge; and asa surgical site infection to: any infections localizated at the incisional site that's ocurrs within 30 days after a surgical procedure or up to year if the protesis was implanted. A cross-sectional descriptive study was designed. Included al patients older than 14 years of age who met the definition of a case. Data collection was performed daily and the information obtained was recorded on a self-made form. A total of 429 infections were registered, with an incidence rate of 8.14 per 1000 hospitalized patients/ day in the year, with a tendency to decline. Surgery and Clinic were the services with the highest rate. Palabras clave: infección hospitalaria; incidencia; tendencia

The strategies on reducing ventilator-associated pneumonia incidence in ICU / 中国基层医药

Objective To understand the incidence trend of ventilator -associated pneumonia(VAP)in ICU and to evaluate the effects of the interventions on the incidence of VAP,so as to provide scientific evidences for the prevention of VAP.Methods A study of 149 patients with VAP occurred in the 3 710 patients of ICU before and after intervention during 7 /2010 -12 /2014 in Wujin People's Hospital,Changzhou city was conducted.It was divided into two stages:baseline survey and stem expectations,VAP interventions included:training and education,chlorhexidine oral care and maintain appropriate endotracheal tube cuff pressure,elevated head of bed to up to 30°and improved hand hygiene.Hospital infection control professionals collected the number of patients,basic information,length of hospital stay,days of receiving mechanical ventilation and the VAP incidence data in ICU.And then change of the VAP incidence of the intervention before and after the intervention was compared and evaluation of the effect of combined intervention measures.Results Prospective data from 3 710 patients hospitalized in ICU were collected for an aggregate of 14 831 days,the utilization rate of ventilator was 55.2%.The occurrence of VAP was 149 cases.The average rate of VAP was 18.2 cases per 1 000 ventilator -day.VAP was associated with a crude mortality of 7.56%and with increased ICU LOS of 13.2d.As the results of the interventions,the rate of VAP was decreased from 52.38 /1 000 during 7 /2010 -6 /2011 to 5.71 /1 000 during 1 /2014 -12 /2014.Conclusion The rate of VAP in the inves-tigated ICU has led to a decreased incidence of VAP under the comprehensive interventions.

Perfil de Sensibilidad y Resistencia Antimicrobiana de Acinetobacter spp. en el Hospital Municipal Boliviano Holandés / Sensitivity profile and antimicrobial resistance of Acinetobacter spp. in the Bolivian Dutch Municipal Hospital

Objetivo: Observar el perfil de sensibilidad y resistencia antimicrobiana de Acinetobacter spp., aislado en pacientes hospitalizados en el Hospital Municipal Boliviano Holandés durante el año 2010 al 2014. Material y métodos: Se revisaron un total de 167 cultivos positivos de Acinetobacter spp. Se realizó un estudio observacional no experimental, descriptivo, retrospectivo, de corte transversal. Resultados: En el antibiograma de los cultivos positivos de Acinetobacter spp. se utilizaron ocho antimicrobianos y se identificó la siguiente sensibilidad y resistencia: a) amikacina, sensibilidad de 25%, sensibilidad intermedia de 2% y resistencia 73%; b) ampicilina más sulbactam, sensibilidad de 22%, intermedia de 8% y resistencia 70%; c) ceftazidime, sensibilidad de 9%, intermedia de 4% y resistencia 87%; d) ciprofloxacina sensibilidad 19%, intermedia 1% y resistencia 80%; e) gentamicina, sensibilidad de 21%, intermedia 0% y resistencia 79%; f) SMX-TMP, sensibilidad de 14%, intermedia de 1% y resistencia 85%; g) imipenem sensibilidad de 61%, intermedia de 1% y resistencia 38%; h) meropenem con sensibilidad de 57%, intermedia 4% y resistencia 39%. Se observó una resistencia absoluta a 6 antimicrobianos. La multidrogoresistencia se identificó en el 41%, la misma que se incrementó progresivamente en los últimos años. Así, en el 2010 se encontró solo 3% de multidrogoresistencia, el 2011 6%, el 2012 y 2013 19% y en el año 2014 53%. Conclusiones: La incidencia de infecciones por Acinetobacter spp., un agente nosocomial de gran importancia clínica, se incrementó de manera progresiva en los últimos años en nuestro hospital al igual que su resistencia. Por ello, se aconseja un uso racional de antimicrobianos y mejorar las medidas de bioseguridad en nuestro nosocomio y en el personal de salud.

Objective: To observe the sensitivity profile and antimicrobial resistance of Acinetobacter spp, isolated from patients hospitalized in the Bolivian Dutch Municipal Hospital during 2010 to 2014. Material and Methods: A total of 167 positive cultures of Acinetobacter spp were reviewed a non-experimental, descriptive, retrospective, observational cross-sectional study was conducted. Results: In the susceptibility testing of positive cultures of Acinetobacter spp. eight antimicrobials were used and the following sensitivity and resistance was identified: a) amikacin, sensitivity of 25%, 2% intermediate sensitivity and resistance 73%; b) ampicillin-sulbactam, sensitivity of 22%, 8% and intermediate resistance 70%; c) ceftazidime, sensitivity of 9%, 4% and intermediate resistance 87%; d) Ciprofloxacin sensitivity 19%, 1% and intermediate resistance 80%; e) gentamicin, sensitivity of 21%, intermediate resistance 0% and resistance 79%; f) TMP-SMX, sensitivity of 14%, intermediate 1% and resistance 85%; g) 61% sensitivity imipenem, intermediate 1% and resistance 38%; h) meropenem with sensitivity of 57%, intermediate resistance and 4% resistance 39%, absolute resistance to 6 antimicrobials was observed. multidrug resistense identified in 41%, the same as it was progressively increased in recentyears. Thus, in 2010 he found only 3% of multidrug, 6% in 2011,2012 and 2013 19% and in 2014 53%. Conclusions. The incidence of infections Acinetobacter spp, a nosocomial agent of great clinical importance, gradually increased in recent years in our hospital as their resistance. Therefore, it is advisable rational use of antimicrobials and improves bio-security measures in our hospital and health personnel.

Estetoscópio: instrumento de diagnóstico e de propagação microbiana? / The stethoscope: is it an instrument for diagnosis orfor microbial dissemination?

O presente artigo teve por objetivo conhecer o potencial de contaminação e disseminação de estetoscópios para infecções relacionadas a serviços de saúde à luz da literatura. A fonte de busca foi a Biblioteca Virtual de Saúde, nas bases de dados Medline, Lilacs e SciELO, realizado no mês de fevereiro de 2015, referente aos anos de 2004 a 2014. Utilizou-se os seguintes critérios de inclusão: teses e periódicos escritos em língua inglesa, espanhola e portuguesa e acessados em texto completo sobre o tema. Foram incluídos nessa revisão 14 artigos. A presença de contaminação e a possível disseminação de micro-organismos pelos estetoscópios foi descrita por todos os estudos analisados. Dessa forma, foi possível identificar que o tema merece maior atenção, já que os estetoscópios podem atuar como vetores para as infecções nosocomiais.

The contamination and dissemination capacity of infections by stethoscopes reported in the literature is analyzed. The Virtual Health Library and databases of Medline, Lilacs and SciELO were used during February 2015 for the 2004 ­ 2014 period. The following inclusion criteria were employed: theses and journals in English, Spanish and Portuguese accessed in full text online. Fourteen articles were included where contamination and possible dissemination of microorganisms by stethoscopes were described. The theme requires deeper attention since stethoscopes may be vectors of hospital infections.

Atuação da equipe multidisciplinar no combate à infecções hospitalares / Role of the multidisciplinary team in fighting hospital infections

Objetivo ­ Avaliar a equipe multidisciplinar e sua funcionalidade, assim como os conceitos de biossegurança adotados por seus profissionais colaborando com a comissão de controle de infecção hospitalar Métodos ­ Para o desenvolvimento deste estudo foi aplicado um questionário de 19 questões objetivas com respostas pré-determinadas a 30 profissionais divididos em 3 grupos. Resultados ­ Observou-se que 13.3% dos profissionais fazem parte da comissão de controle de infecção. A questão da água corrente e limpa deixa no ar a qualidade da higienização, uma vez que a cidade enfrenta problemas sérios quanto à escassez e qualidade da água. Os pontos mais críticos foram encontrados na não higienização das mãos ao se mover de um sitio anatômico contaminado para outro com dados de 20%, contato com áreas próximas a paciente, objetos inanimados com não adesão de 34%. A taxa de profissionais sem conhecimento de realização de culturas foi de 24%. Falta de procedimentos escritos sobre exposição a material perfuro cortante foi de 24%. Conclusão ­ A equipe multidisciplinar não está seguindo corretamente o ideal preconizado pelo Ministério da Saúde, este trabalho evidenciou várias falhas em seus procedimentos quanto á higienização das mãos.

Objective ­ Evaluate the multidisciplinary team and its functionality, as well as the concepts of biosafety adopted by practitioners working with the commission of hospital infection control Methods ­ To develop a questionnaire study of 19 objective questions with predetermined answers to 30 professionals divided into 3 groups was applied. Results ­ It was observed that 13.3% of professionals are part of the infection control committee. The issue of clean running water makes the air quality of hygiene, since the city faces serious problems regarding the scarcity and quality of water. The most critical points were found in not washing hands when moving from one anatomical site to another with tainted data of 20%, close contact with the patient, inanimate objects with non-adherence of 34% areas. The rate without professional knowledge to conduct crop was 24%. Lack of written procedures overexposure cut and puncture wounds material was 24%. Conclusion ­ The multidisciplinary team is not properly following the ideal advocated by the Ministry of Health, this study revealed several flaws in their procedures regarding hand hygiene

Concordância dos resultados do sistema BD Phoenix com provas bioquímicas manuais na identificação de enterobactérias em amostras clínicas / Agreement of results of the BD Phoenix system and manual biochemical tests in the identification of Enterobacteriaceae from clinical samples

Enterobactérias pertencem a um grupo grande e heterogêneo de bacilos Gram-negativos cujo habitat natural é o cólon de humanos e animais, sendo microrganismos amplamente distribuídos na natureza. Devido a essas características são frequentemente responsáveis por infecções hospitalares. O principal objetivo desse estudo foi avaliar a concordância entre as provas bioquímicas manuais e o sistema automatizado BD Phoenix 100 na identificação de enterobactérias, a partir da análise de registros de pacientes hospitalizados. Métodos: No período de agosto de 2011 a abril de 2012, foram realizados 303 exames no Laboratório Exame de Análises Clinicas pelos métodos manual e automatizado, os quais foram submetidos a análise dos dados. Resultados: Do total, 27,7% foram positivos para enterobactérias. Os microrganismos mais frequentes isolados foram a Klebsiella pneumoniae (36,9%) e Escherichia coli (29,8%). O estudo apresentou uma alta concordância entre os métodos, principalmente na identificação dos gêneros, caso em que a concordância chegou a 97% dos registros. Na identificação das espécies, as bactérias dos gêneros Klebsiella spp. e Serratia spp. não tiveram suas espécies identificadas pelo método manual em sete dos registros observados, sendo identificadas somente pela automação. Da mesma forma, algumas amostras de Escherichia coli não foram detectadas pelo método manual, que as identificou como indeterminadas em quatro dos registros analisados. Conclusão: Verificou-se uma boa concordância entre os métodos na identificação das principais enterobactérias isoladas de amostras clínicas...

Enterobacteriaceae are microorganisms that are widely distributed in nature and belong to a large and heterogeneous group of Gram-negative bacilli whose natural habitat is the colon of human beings and animals and are. Because of these characteristics they are often responsible for hospital infections. The main objective of this study was to assess the agreement between manual biochemical tests and the BD Phoenix 100 automated system in the identification of the Enterobacteriaceae, based on an analysis of hospitalized patients’ records. Methods: In the period between August 2011 and April 2012, 303 tests were made at Laboratório Exame de Análises Clinicas by the manual and automated methods, which were subjected to analysis. Results: Results revealed that 27.7% of the tests were positive for Enterobacteriaceae. The most commonly isolated microorganisms were Klebsiella pneumoniae (36.9%) and Escherichia coli (29.8%). The study showed a high agreement between the methods, especially in the identification of genders, in which case agreement reached 97% of records. When it comes to identifying the species, seven samples of Klebsiella spp. and Serratia spp. bacteria had their species identified only by the automated method and not by the manual method. Similarly, some samples of Escherichia coli, were not detected by the manual, which identified them as indeterminate in four of the records analyzed. Conclusions: There was a good agreement between both methods in identifying the major Enterobacteriaceae isolated from clinical samples...